SPORTS MEDICINE Consideration of religious sentiments while selecting a biological product for knee arthroscopy Deepak Goyal • Anjali Goyal • Mats Brittberg Received: 6 June 2012 / Accepted: 29 October 2012 / Published online: 10 November 2012 Ó Springer-Verlag Berlin Heidelberg 2012 Abstract Purpose There is an increasing use of various synthetic and biological products in orthopaedics. The use of a biological product can be a major area of concern for patients of various cultures/religions. The purpose of this work is to study various restrictions in different faiths and their compatibility with available products focused on cartilage repair. Methods A systematic search in several databases, CINAHL, EMBASE, Global health, PubMed, MEDLINE and the Cochrane collaboration, was performed to find out various religious beliefs of some major religions regarding the use of animal products. Hindu, Muslim, Christian, Jewish and Buddhist faiths were studied to find out whether animal-derived surgical implants are permitted. Major religious scholars were asked about their opinions, and guidelines related to human/religious ethics were evalu- ated. A market survey was carried out to find out biological contents of various products and their compatibility. Results Jews and Muslims have religious restrictions for porcine products, while Hindus reject bovine products. Vegetarian Hindus reject usage of any animal product. Most Christians do not have any restrictions except those who follow vegetarian dietary regulations. Though there is no prohibition for the use of animal products in Buddhism, a code of non-violence to animals is being followed. However, difference of opinion exists about interpretation of these dietary guidelines for surgical usage amongst various scholars. Conclusion Products of biological origin have a definite restriction for various religions, with few exceptions. Sur- geons should know the source of the product and should be aware of the basic requirements of the patient’s faith. Patient should be informed about the source of the product and alternative if available, and an informed consent may be considered. Level of evidence Type of study, Level V. Keywords Animal origin Á Cartilage products Á Meniscus implants Á Religion Á Restriction Á Culture Á Hindu Á Jews Á Muslim Á Christian Á Human ethics Á Xenografts Introduction There is an increasing use of synthetic and biological products for various arthroscopy and cartilage surgeries. Meniscus implants, cultured chondrocytes and scaffolds for cartilage products are becoming popular [38, 59, 61]. Apart from the various biological, structural and mechanical properties that a product must qualify, certain religious and cultural issues must also be taken into account while selecting these products. Some cultural or religious cus- toms forbid the dietary use of substances from certain animal sources, and such issues may limit or prevent its surgical use by certain patients [39]. While treating an ailment, such issues are of least importance to many; but D. Goyal (&) Saumya Orthocare, Centre for Advanced Surgeries of the Knee Joint, Sabarmati, Ahmedabad 380005, India e-mail: deepak@knee.in URL: www.knee.in A. Goyal Smt NHL Municipal Medical College, Ellis Bridge, Ahmedabad, India M. Brittberg Cartilage Research Unit, Region Halland Orthopaedics, Hallands Hospital Kungsbacka, University of Gothenburg, 434 80 Kungsbacka, Sweden 123 Knee Surg Sports Traumatol Arthrosc (2013) 21:1577–1586 DOI 10.1007/s00167-012-2292-z